Healthcare Provider Details

I. General information

NPI: 1578339560
Provider Name (Legal Business Name): ANGELICA L COLLINS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 BRIARFIELD BLVD STE 300
MAUMEE OH
43537-8916
US

IV. Provider business mailing address

801 ROSEHILL RD
JACKSON MI
49202-1762
US

V. Phone/Fax

Practice location:
  • Phone: 419-452-2140
  • Fax: 419-873-6327
Mailing address:
  • Phone: 517-212-2008
  • Fax: 517-212-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0035340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: